TY - JOUR
T1 - Association between objectively measured protein intake and muscle status, health-related quality of life, and mortality in hemodialysis patients
AU - Salamah, Sovia
AU - Post, Adrian
AU - Alkaff, Firas F.
AU - van Vliet, Iris M.Y.
AU - Ipema, Karin J.R.
AU - van der Veen, Yvonne
AU - Doorenbos, Caecilia S.E.
AU - Corpeleijn, Eva
AU - Navis, Gerjan
AU - Franssen, Casper F.M.
AU - Bakker, Stephan J.L.
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/10
Y1 - 2024/10
N2 - Background: Protein intake is known to be associated with muscle mass, health-related quality of life (HRQoL), and mortality in patients with stage 5 chronic kidney disease undergoing dialysis. However, most studies evaluated protein intake based on 24 h dietary recall or food frequency questionnaire, and these methods are prone to bias. Therefore, this study aimed to evaluate the association of objectively measured protein intake with muscle mass and strength, HRQoL, and mortality.Methods: Dietary protein intake was calculated based on the combined (urinary and dialysate) urea excretion rate according to the Maroni formula and indexed to body weight. Muscle mass was calculated based on the combined dialysate and urinary creatinine excretion rate, and muscle strength was assessed by handgrip strength. HRQoL was based on the Short Form 36. Linear and Cox regression were used for the analyses.Results: We included 59 hemodialysis patients (mean age 65 ± 15 years, 37% female, median hemodialysis vintage 15 [6–39] months). Mean protein intake was 0.82 ± 0.23 g/kg/day, and 76% had a low protein intake (<1.0 g/kg/day). Higher protein intake was independently associated with higher muscle mass (Standardized beta (St. β) [95% confidence interval (95%CI) = 0.56 [0.34 to 0.78]) and higher scores on the physical functioning domain of HRQoL (St. β [95%CI] = 0.49 [0.25 to 0.73]), but not with muscle strength (St. β [95%CI] = 0.17 [-0.10 to 0.43]). During a median follow-up of 21.6 [8.6–36.6] months, 16 (27.1%) patients died. Higher protein intake was associated with lower mortality risk (hazard ratio [95%CI] = 0.34 [0.16–0.73]). This association remained significant after adjustment for potential confounders.Conclusions: Protein intake is independently associated with muscle mass, physical functioning domain of HRQOL, and mortality. Clinicians and dietitians should closely monitor the protein intake of hemodialysis patients.
AB - Background: Protein intake is known to be associated with muscle mass, health-related quality of life (HRQoL), and mortality in patients with stage 5 chronic kidney disease undergoing dialysis. However, most studies evaluated protein intake based on 24 h dietary recall or food frequency questionnaire, and these methods are prone to bias. Therefore, this study aimed to evaluate the association of objectively measured protein intake with muscle mass and strength, HRQoL, and mortality.Methods: Dietary protein intake was calculated based on the combined (urinary and dialysate) urea excretion rate according to the Maroni formula and indexed to body weight. Muscle mass was calculated based on the combined dialysate and urinary creatinine excretion rate, and muscle strength was assessed by handgrip strength. HRQoL was based on the Short Form 36. Linear and Cox regression were used for the analyses.Results: We included 59 hemodialysis patients (mean age 65 ± 15 years, 37% female, median hemodialysis vintage 15 [6–39] months). Mean protein intake was 0.82 ± 0.23 g/kg/day, and 76% had a low protein intake (<1.0 g/kg/day). Higher protein intake was independently associated with higher muscle mass (Standardized beta (St. β) [95% confidence interval (95%CI) = 0.56 [0.34 to 0.78]) and higher scores on the physical functioning domain of HRQoL (St. β [95%CI] = 0.49 [0.25 to 0.73]), but not with muscle strength (St. β [95%CI] = 0.17 [-0.10 to 0.43]). During a median follow-up of 21.6 [8.6–36.6] months, 16 (27.1%) patients died. Higher protein intake was associated with lower mortality risk (hazard ratio [95%CI] = 0.34 [0.16–0.73]). This association remained significant after adjustment for potential confounders.Conclusions: Protein intake is independently associated with muscle mass, physical functioning domain of HRQOL, and mortality. Clinicians and dietitians should closely monitor the protein intake of hemodialysis patients.
KW - Chronic disease
KW - Fatigue
KW - Health-related quality of life
KW - Hemodialysis
KW - Muscle strength
KW - Protein intake
UR - http://www.scopus.com/inward/record.url?scp=85201908483&partnerID=8YFLogxK
U2 - 10.1016/j.clnesp.2024.08.011
DO - 10.1016/j.clnesp.2024.08.011
M3 - Article
C2 - 39154804
SN - 2405-4577
VL - 63
SP - 787
EP - 795
JO - Clinical Nutrition ESPEN
JF - Clinical Nutrition ESPEN
ER -